Training Geriatric Psychiatry Fellows in the Medicolegal Aspects of Psychiatric Consultation in the Nursing Home

By Valdez, Karen A.; Maust, Donovan T. et al. | Journal of Psychiatry & Law, Spring 2012 | Go to article overview

Training Geriatric Psychiatry Fellows in the Medicolegal Aspects of Psychiatric Consultation in the Nursing Home


Valdez, Karen A., Maust, Donovan T., Streim, Joel E., Journal of Psychiatry & Law


Accredited fellowship training programs in geriatric psychiatry are required to address ethical and legal issues pertaining to mental health in older adults, and to provide clinical experiences that enable trainees to develop competencies in long-term care consultation. The growing number of criminal offenders with mental illness and other disabling conditions that require long-term care, along with comprehensive federal regulations that affect mental health care in nursing homes, is creating a more urgent public health need to train psychiatrists with specific competencies in patient care, interpersonal skills and communication, and systems-based practice as they apply to medicolegal aspects of psychiatric consultation in the nursing home setting. This article reviews legal and regulatory information that is pertinent to training fellows in the care of elderly nursing home residents with mental illness or behavioral problems. It describes several aspects of the Geriatric Psychiatry Fellowship Training Program at the University of Pennsylvania that promote development of skills in geriatric psychiatry consultation in nursing homes.

KEY WORDS: Forensic psychiatry, geriatric psychiatry, psychiatric consultation, nursing homes.

Since 2003, the Accreditation Council on Graduate Medical Education (ACGME) has required that the curricula of clinical fellowship programs in geriatric psychiatry address "the ethical and legal issues especially pertinent to geriatric psychiatry, including competence, guardianship, right to refuse treatment, wills, informed consent, elder abuse, the withholding of medical treatments, and federal legislative guidelines governing psychotropic drug prescription in nursing homes" (ACGME, 2003). The subspecialty program requirements also emphasize attainment of skills as a consultant, and specifically mandate "consultative experience in chronic care facilities" (ACGME, 2003). Despite these longstanding training requirements, there are no standardized, comprehensive curricula for teaching forensic aspects of geriatric psychiatry; and to our knowledge, there is no published guidance on the preparation of psychiatrists to serve as consultants on the medicolegal aspects of long-term care for older adults.

The challenge for geriatric training is one of growing public health significance, because long-term care facilities continue to experience a rise in the admission of criminal offenders with histories of mental illness who also require specialized medical care (Cohen, Hays, & Molinari, 2011). They include (but are not limited to) registered sex offenders, parolees, and inmates transferred by correctional authorities. While policies and criteria for admission vary between facilities and states, practices for risk assessment of offenders, and education of staff about behavioral management to protect themselves and other vulnerable residents, while preserving the rights of the offenders, are less well understood. Moreover, policies and practices developed by facilities must conform with federal regulations that protect the rights of individuals in long-term care facilities.

In this article, we describe several aspects of the Geriatric Psychiatry Fellowship Training Program at the University of Pennsylvania (Penn) that are specifically designed to promote the development of competencies in patient care, interpersonal skills and communication, and systems-based practice as they apply to medicolegal aspects of psychiatric consultation in the nursing home setting. We review legal and regulatory information that is pertinent to training fellows in the care of elderly nursing home residents with mental illness or behavioral problems. For heuristic purposes, we illustrate with vignettes from a case involving an elderly patient with chronic psychiatric and medical problems requiring longterm care, whose history of a sexual offense and whose current behaviors complicate his management and raise ethical and legal dilemmas for the nursing home staff and administrators.

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

Training Geriatric Psychiatry Fellows in the Medicolegal Aspects of Psychiatric Consultation in the Nursing Home
Settings

Settings

Typeface
Text size Smaller Larger
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Full screen

matching results for page

Cited passage

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited passage

Welcome to the new Questia Reader

The Questia Reader has been updated to provide you with an even better online reading experience.  It is now 100% Responsive, which means you can read our books and articles on any sized device you wish.  All of your favorite tools like notes, highlights, and citations are still here, but the way you select text has been updated to be easier to use, especially on touchscreen devices.  Here's how:

1. Click or tap the first word you want to select.
2. Click or tap the last word you want to select.

OK, got it!

Thanks for trying Questia!

Please continue trying out our research tools, but please note, full functionality is available only to our active members.

Your work will be lost once you leave this Web page.

For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

Already a member? Log in now.